What Is Alcohol Use Disorder?
Alcohol use disorder (AUD) is a chronic illness in which you can’t stop or control your drinking even though it’s hurting your social life, your job, or your health.
It’s a range that includes alcohol abuse, which is when drinking has serious consequences again and again. It also includes alcohol dependence or alcoholism, which is when you’ve lost control of your drinking.
How much alcohol is too much?
If you’re going to drink, experts recommend doing it in moderation. This means no more than one drink a day if you're a woman and no more than two if you're a man. One drink equals:
- 1.5 ounces of liquor (like whisky, rum, or tequila)
- 5 ounces of wine
- 12 ounces of beer
Another way to look at your drinking habits is to think about how much you have during an average week. For women, "heavy" or "at risk" drinking means more than seven drinks per week or more than three in any day. For men, it's more than 14 drinks in a week or more than four in a day.
Alcohol Use Disorder Symptoms
An estimated 16 million people -- adults and adolescents -- in the U.S. have alcohol use disorder.
The signs of AUD can include:
- An uncontrollable urge to drink or craving alcohol
- Lack of control over how much you drink
- Negative thoughts when you're not drinking alcohol
- Drinking in risky situations
- Drinking that interferes with things you enjoy
- Continuing to drink even though it causes drink or makes them worse
- Stopping important activities or doing them less often because of alcohol
Learn more about AUD symptoms.
Types of Alcohol Use Disorder
There are mild, moderate, and severe forms of AUD, which depend on how many symptoms you have. You may have AUD if one or more of these statements is true:
- You can't relax or fall asleep without drinking.
- You need a drink in the morning to get going.
- To be social, you have to drink.
- Alcohol serves as your escape from feelings.
- After drinking, you drive.
- You mix alcohol and medications.
- You drink when you're pregnant or caring for small children.
- When loved ones ask how much you drink, you don't tell the truth.
- You hurt people or become angry when you drink.
- It's tough for you to remember what you did when you were drinking.
- Your responsibilities suffer because of your drinking.
- Drinking has caused you legal problems.
- You tried to stop drinking but failed.
- You can't stop thinking about drinking.
- To feel the effects of alcohol, you have to drink more and more.
- You have withdrawal symptoms after you stop drinking for too long, like shakiness, nausea, trouble sleeping, or seizures.
Alcohol Use Disorder Causes and Risk Factors
Different things can cause alcohol use disorder or make it more likely in different people. These include:
- Low self-esteem
- A need for approval
- Trying to cope with emotional problems
- Peer pressure
- Easy access to alcohol
- Low socioeconomic status
- Physical or sexual abuse
- A family history of alcohol problems
- Regular binge drinking
- Drinking at an early age
- Bariatric surgery
Alcohol Use Disorder Diagnosis
Your doctor may ask about your drinking habits and want to talk with your family and friends. They might also do a physical exam and order lab tests to learn whether alcohol use is affecting your health.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders says someone has alcohol use disorder if they meet two or more of 11 criteria in one 12-month period. AUD may be mild, moderate, or severe, based on how many of the criteria are true.
The criteria are:
- Alcohol use in larger amounts or for a longer time than intended
- A lasting desire or unsuccessful effort to cut down or control alcohol use
- A lot of time spent getting alcohol, drinking it, or recovering from its effects
- A craving for alcohol
- Alcohol use that causes a failure to meet obligations at work, school, or home
- Alcohol use that continues even though it leads to lasting or repeated personal problems
- Giving up or cutting back on important activities because of alcohol
- Repeatedly using alcohol in dangerous situations
- Using alcohol even though you know it causes physical or psychological problems, or makes them worse
- Alcohol tolerance, when you need more to have the same effect
- Alcohol withdrawal
Learn more about whether you might have alcohol use disorder.
Alcohol Use Disorder Stages
Alcohol use disorder can start out as just alcohol use. It can go through stages, including:
- At risk: You may have drinks when you're out with friends or have a drink to lower your stress. At this point, your body starts to tolerate alcohol.
- Early AUD: You may start drinking alone or in secret, and you're thinking about alcohol a lot. You may have blackouts from drinking.
- Mid-stage AUD: You can't control your drinking. It's causing problems with your work, finances, family, and physical and mental health.
- End-stage AUD: Almost all you think about is drinking and you don't care about food, family, friends, health, or happiness. Your have serious organ damage and are in danger of dying from this condition.
Alcohol Use Disorder Treatment
Depending on your case, you can get one or more types of treatment for alcohol use disorder. The main goal is to avoid alcohol and find a better quality of life.
You may experience alcohol withdrawal if you stop drinking suddenly. Alcohol withdrawal can be life-threatening. Symptoms of alcohol withdrawal include:
- Tremors or shakes
- Nausea and vomiting
- Heart palpitations
- Higher blood pressure or heart rate
- Fast, unnatural breathing
Get medical attention if you have these symptoms. Alcohol withdrawal can usually be treated outside of the hospital, but some severe cases do require hospitalization.
Counseling and support
Therapy, whether alone or as part of a group, can help you understand your disorder and what may have caused it. You’ll get assistance staying away from alcohol and sticking with your treatment plan. The support of your loved ones is important, so they might need or want to be involved too.
If you have moderate or severe AUD, your doctor may prescribe one or more of these medications:
- Acamprosate (Campral)
- Disulfiram (Antabuse)
- Naltrexone (ReVia, Vivitrol)
- Topiramate (Topamax)
People who have serious AUD may need to live in a treatment facility staffed by medical professionals who have experience treating the disorder. Most programs involve therapy, support groups, education, and other activities.
Learn more about alcohol use disorder treatments.
How Alcohol Use Disorder Affects Different Groups
A U.S. government survey says 29.5 million people aged 12 and older had AUD in 2021. Of those:
- 18.7 million are White.
- 5.1 million are Latino.
- 3.5 million are Black.
- Almost a million are Asian.
- 424,000 are American Indian, Alaska Native, Native Hawaiian, or Pacific Islander.
Not everyone gets the same access to screenings for alcohol use. A study involving almost 1,000 people found that Black and Latino people and other ethnic groups were less likely than White people to get "quality" alcohol screenings. These screenings are when health care professionals ask people not only if they drink, but also how much they drink. That's important in finding out whether someone is a heavy drinker, so they can get the right treatment. The study found other things also affected whether people got quality alcohol screenings. Black, Latino, and other ethnic groups who had a high school education or less and who were on Medicare or Medicaid were also less likely to get the more detailed screenings. This means people in these groups could be missing out on key preventive care and treatment.
Alcohol Use Disorder Effects and Complications
Even if your case of AUD is mild, it can have a serious effect on your physical and mental health. Often, AUD causes other problems that you try to avoid by drinking. That creates a negative cycle.
In the short term, AUD can cause:
- Memory loss
Long-term effects and complications may include:
- Stomach problems
- Heart problems
- Brain damage
- Permanent memory loss
- High blood pressure
- Cirrhosis, or scarring on your liver
You're also more likely to take dangerous risks. That raises your chances of being injured or dying from:
- Car accidents
AUD affects people around you, too. Your drinking may damage relationships with loved ones because of anger problems, violence, neglect, and abuse. Pregnant women risk having a miscarriage. Their babies are more likely to have fetal alcohol syndrome and sudden infant death syndrome (SIDS).
Living With Alcohol Use Disorder
Depending on the stage of your AUD, it might feel overwhelming. But treatment can help. You can call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline 24 hours a day at 800-662-HELP (4357). Alcoholics Anonymous also has offices in most areas. Other organizations have support groups and recovery programs for you or someone you love. Your doctor can help you find one.
There are things you can do to help yourself in addition to your treatment (you shouldn't do these things instead of your treatment):
- Meditation can help focus your mind and make you calmer and less stressed.
- Yoga may also help you relax and deal with stress.
- Change the way you socialize. Let your friends and family know you're not drinking, and get a group of friends who support you in that decision.
- Do things that don't include alcohol. If drinking was tied to your activities, get new hobbies.
- Change to healthier habits. Exercise, lowering your stress, getting good sleep, and eating nutritious foods can put you on a good path for AUD recovery.
Prognosis or Outlook With Alcohol Use Disorder
Recovery from AUD is possible. It can be a challenge for many people. Setbacks are common. Getting help as early as possible can keep you from drinking again. Your doctor might suggest talk therapy to help you learn how to deal with triggers that might cause you to want to drink. And some medications can help when situations come up that may put you at risk for drinking again, such as the death of a family member, the loss of a job, or divorce.